Provider Demographics
NPI:1215753702
Name:RODRIGUEZ, NATHALIA (RDH)
Entity type:Individual
Prefix:
First Name:NATHALIA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 MCDAVITT PL
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-3509
Mailing Address - Country:US
Mailing Address - Phone:973-960-7357
Mailing Address - Fax:
Practice Address - Street 1:36 MCDAVITT PL
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-3509
Practice Address - Country:US
Practice Address - Phone:973-960-7357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJW6S6B4D4202K00000X
NJ22HI01271400124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology